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Thrombophlebitis of the lower extremities: causes, symptoms and treatment

What it is?

When a blood clot develops inside the vein and inflammation of the inner wall occurs with impaired blood flow, it is thrombophlebitis. It should be distinguished from phlebothrombosis, in which a thrombus forms on the intact (non-inflamed) vascular wall. The course of the disease can be acute and chronic.

thrombophlebitis of superficial veins

thrombophlebitis of superficial veins, photo 1

Acute thrombophlebitis is characterized by a more pronounced inflammation of the venous wall and an intense pain syndrome. Against this background, the risk of developing complications such as thrombosis and thromboembolism (venous thrombus entering the vessels of various organs) increases markedly.

Particularly dangerous is pulmonary embolism, which can be fatal if vessels of large diameter are blocked.

Thrombophlebitis can affect the veins of both the upper and lower torso. The last option is the most common, because hemodynamic (blood circulation) features predispose to it. Acute thrombophlebitis of the lower extremities differs in the depth of localization of the affected vessels.

It is divided into:

  • thrombophlebitis of the superficial veins (photo 1);
  • deep vein thrombophlebitis.

Content

Causes

The appearance of venous thrombosis is associated with three main factors. They were first pointed out by the eminent physiologist Rudolf Virchow. Since then, they are called the Virchow triad and are the basis for understanding the mechanisms of disease development:

  1. Reducing the speed of blood flow in the vessel.
  2. Blood coagulation due to changes in its composition.
  3. Violation of the integrity of the inner lining of the vessel.

These factors, both individually and in combination, are observed in certain diseases and conditions. Their presence is the background for the development of thrombophlebitis.

These include:

  • tendency to increased blood coagulation due to hypercoagulability or an increase in the number of platelets;
  • varicose veins (varicotrombophlebitis is the most common form of acute thrombophlebitis of the superficial veins);
  • forced long-term immobility of the limb (for example, immobilization after a hip fracture, which can last for 3-6 months);
  • the period of pregnancy and immediately after childbirth (at this time there is a physiological activation of the coagulation processes necessary to prevent bleeding in the postpartum period. However, in the presence of an injured or inflamed venous wall, this process can trigger massive thrombosis);
  • taking hormones, especially estrogen-containing. They have a direct effect on the activation of coagulation factors.
    systemic inflammatory process that develops in infectious diseases or autoimmune, when the immune system is directed against its own cells;
  • oncological diseases - the majority of tumor cells secrete factors that stimulate the internal coagulation mechanism
    damage and infection of the vein wall with injuries or intravenous injections, the installation of an intravenous catheter, as well as during its prolonged stay in the venous bed. This creates conditions for turbulent blood flow, in which platelet aggregation increases.

Symptoms of thrombophlebitis of the lower extremities, photo

Symptoms of vessel lesion, photo 2

Symptoms of vessel lesion, photo 2

The overall picture of thrombophlebitis is formed from the manifestations of the inflammatory process and symptoms of disruption of the normal blood flow in the affected veins. With superficial thrombophlebitis of the lower extremities, the symptoms are divided into general and local:

1. General symptoms indicating an inflammatory process. As a rule, they are similar to signs of flu (flu-like syndrome). Therefore, very often, with the initial absence of local manifestations, diagnosis is difficult.

They include:

  • increased body temperature;
  • malaise, weakness;
  • aches in muscles and joints.

2. Symptoms determined directly above the affected vessel.

These are signs of local inflammation (photo2):

  • compaction and tenderness of the veins during palpation;
  • hyperemia (redness) and a local increase in skin temperature over the vein;
  • lameness due to pain.

With deep vein thrombosis, the clinical signs of lower extremity thrombophlebitis will be more pronounced (see photo). In addition to the flu-like syndrome and an increase in local temperature, severe pains of the arching nature, significant edema, cyanosis (cyanosis) appear in the limb.

deep vein thrombophlebitis of the lower extremities

deep vein thrombophlebitis of the lower extremities, photo 3

This symptom is defined below the level of blood flow blockage by a blood clot. According to statistics, the most common is the involvement in the pathological process of the veins of the leg and the lower third of the thigh.

Therefore, quite often in patients is determined by the pain when probing the gastrocnemius muscle and pain when raising the foot in the position of "over". The appearance of any of these signs, as well as the "inexplicable" puffiness, is an indication for an urgent consultation of a phlebologist.

Diagnosis of thrombophlebitis

Diagnosis of thrombophlebitis Establishing a diagnosis consists of two stages - preliminary and final.

The first involves a thorough conversation of the doctor with the patient and conducting an objective examination - examination and palpation (palpation).

At the second stage, additional diagnostic tests are assigned that help to visualize an existing thrombus and assess the condition of the venous wall.

More detailed diagnosis of thrombophlebitis is as follows.

During the interview, the patient specifies:

  • when the disease occurred (in acute thrombophlebitis there is a sudden onset, among full health);
  • what was the initial manifestation (the first signs are pain and swelling of the limb);
  • is there any connection with trauma, pregnancy and other factors, i.e. presence of causal and predisposing conditions;
  • whether the patient has congenital or acquired coagulation disorders that increase the likelihood of thrombosis;
  • experience taking hormones especially for contraceptive purposes;
  • what are the concomitant diseases besides thrombophlebitis. It is important to select the most rational therapy to minimize side effects.

On examination of the patient, the doctor assesses a number of important signs that allow to judge about the presence of thrombophlebitis and the possible development of complications:

1) General condition and adequacy of vital functions, such as respiration and blood circulation (assessment of blood pressure and pulse, respiratory rate, total body temperature).

2) The state of both lower limbs , determined visually and by palpation. It allows you to identify the presence of local symptoms - pain, redness, increase in local temperature. A mandatory step is to check the pulsation of the arteries of the extremities.

This eliminates the complete overlap of the blood supply to the thrombus, which is dangerous for the development of gangrene of the limb, ending with amputation.

ECG is performed in case of dyspnea and pronounced swelling of the affected limb. Based on the obtained graphical results, pulmonary thromboembolism (PE) can be diagnosed.

For the final verification of this complication, an x-ray examination of the lungs is performed.

There are specific laboratory tests to determine the presence of thrombosis. These include:

  • Plasma D-dimer (less than 500 µg / l in normal) - its increase indicates thrombosis;
  • deployed coagulogram (assesses the state of coagulation and anticoagulation systems);
  • counting the number of platelets produced by clinical blood analysis.

Instrumental examination includes ultrasound duplex scanning of blood vessels. With it, the doctor receives valuable diagnostic information:

  • condition of patency of the veins of the extremities;
  • the functional state of the deep vein valves;
  • the presence of a blood clot in the lumen of a vein, its size, the likelihood of movement, "maturity" ("immature" blood clots are more dangerous because they are easier to tear off and carried by the blood flow);
  • what are the permeability of peripheral arteries.

When making a diagnosis of "superficial thrombophlebitis," it is necessary to exclude the presence of other similar diseases:

  • erysipelas ;
  • skin infections;
  • inflammation of the lymphatic vessels (lymphangitis).

Note: it is more correct to use the term "thrombophlebitis of the lower extremities", and not "thrombophlebitis of the veins of the lower extremities", since "phlebitis" already means inflammation of the veins, i.e. get a tautology.

Methods for treating lower limb thrombophlebitis

treatment of thrombophlebitis of the lower extremities

With an acute attack of thrombophlebitis of the lower extremities, the appearance of severe pain, treatment should begin urgently - even by the doctors of the ambulance team, which must be called immediately.

It consists in adequate anesthesia and prevention of the progression of blood clots. For this purpose, use heparin in / in a single dose, aspirin orally, analgin in / in. Currently, low molecular weight anticoagulants (for example, Fraxiparin) have replaced heparin. They have fewer side effects and high efficacy.

Subsequently, when possible, medical supervision and implementation of daily laboratory monitoring of platelet levels, a 5-day course of anticoagulants is prescribed. At the same time, rivaroxaban is preferred - an indirect anticoagulant, the use of which does not increase the risk of massive bleeding.

Hospitalization in the Department of Vascular Surgery is carried out in the absence of conditions for treatment outside the hospital, as well as at high risk of developing life-threatening conditions.

It is shown in the following cases:

  • clinical, radiological and electrocardiographic signs of pulmonary embolism;
  • extensive thrombosis confirmed by duplex scanning;
  • thrombophlebitis of the thigh (large saphenous vein), in which the risk of thromboembolism is increased many times;
  • thrombophlebitis of the small saphenous vein;
  • vena cava thrombosis (upper and lower);
  • clinical and laboratory deterioration during treatment outside the hospital with superficial thrombophlebitis;
  • detection with ultrasound of a mobile thrombus, which can come off at any time.

During transport of the patient, it is necessary to give the affected limb an elevated position. In case of refusal of hospitalization, the patient is recommended to urgently contact the clinic. At the same time, ambulance doctors carry out an active call to the local doctor at home.

Treatment of thrombophlebitis of the legs

Treatment of thrombophlebitis of the legs

In the hospital, the type and tactics of treatment is determined by the vascular surgeon.

Supporting therapeutic points are:

  • intensive anticoagulation (anti-clotting) therapy (warfarin, heparin, enoxaparin);
  • the use of thrombolytic (destructive thrombus) drugs - they are effective only in the first hours after the formation of a blood clot (for this reason you should immediately seek medical help);
  • nonsteroidal anti-inflammatory drugs;
  • antibiotic therapy at the accession of the infectious process;
  • in the absence of pain, elastic compression is performed (bandaging, wearing elastic knitwear);
  • control of platelet levels and APTT (partially activated thromboplastin time) 1-2 times a day for the first days, then regularly during the entire period of hospitalization;
  • early but gradual and careful activation of the patient after bed rest, because the risk of blood clot is high;
  • prevention of thrombus penetration into the deep vein system. For this purpose, according to indications, Troyanov's operation is performed on ligation of the great saphenous vein (the decision is made individually in cases if thrombophlebitis is detected above the knee joint).

In order to prevent the appearance of new symptoms in thrombophlebitis of the lower extremities, additional local treatment is carried out. It consists in the use of various alcohol compresses, ointments, gels, etc.

Used ointments in the treatment of superficial thrombophlebitis of the lower extremities are classified into 3 groups:

  1. Heparin-containing (Lioton, Gepatrombin) - reduce the risk of re-thrombosis.
  2. With nonsteroidal anti-inflammatory components (indovazin, diclofenac, indomethacin), allowing you to quickly arrest the inflammatory response.
  3. Flebotonichesky with rutozid, trokserutinom (trosekevazidom), strengthen the venous wall.

Prognosis for thrombophlebitis

Forecast Acute superficial thrombophlebitis has a favorable prognosis compared with deep. After carrying out the necessary treatment, the symptoms quickly disappear, but the consolidation of the vein may persist for some time.

If untreated, the greatest danger is the penetration of a thrombus from the surface into the system of the deep veins, which can aggravate the condition and lead to the development of deep thrombophlebitis.

In turn, thrombophlebitis of the deep veins of the lower extremities may be complicated by pulmonary thromboembolism. Its development occurs when the embolization of a detached thrombus enters the pulmonary artery system.

The sudden onset of shortness of breath in combination with swelling and pain in the leg may indicate the development of this complication. This shows the emergency hospitalization of the patient.

Prevention

Preventive measures against thrombophlebitis include:

  • treatment of varicose veins, preventing them from thrombosis and inflammation;
  • wearing elastic knitwear during pregnancy, high platelet count, hormonal intake;
  • early activation of the limb after fractures and other injuries, as well as prolonged bed rest;
  • compliance with the rules of antiseptics when conducting i / v injection. Avoid the introduction of drugs in the veins of the legs;
  • close monitoring of the state of the intravenous catheter and its installation for no more than 3 days;
  • administration of small doses of heparin and its analogues in the postoperative period in patients with varicose veins or cases of thrombophlebitis in the past;
  • physical therapy, swimming;
  • regular foot massage

Thrombophlebitis of the lower extremities in ICD 10

In the international classification of diseases of thrombophlebitis of the lower extremities is:

Class IX. Diseases of the circulatory system (I00 — I99)

I80-I89 - Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified

I80 - Phlebitis and thrombophlebitis

  • I80.3 - Phlebitis and thrombophlebitis of the lower extremities, unspecified
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